<wicket:extend>
	<div class="content">
		<div class="container">
			<div class="page-header">
				<h1>Preferences</h1>
			</div>
			<div class="row">
				<!-- <div class="span6 offset3"> -->
				<div class="well">
					<form id="tab" class="form-horizontal" wicket:id="userForm">
						<fieldset>
							<div class="span4 smvlabel">
								<!-- Text input-->
								<div class="control-group">
									<label class="control-label" for="fName">First Name</label>
									<div class="controls">
										<input id="fName" name="fName" type="text"
											placeholder="First Name" class="input-xlarge" required=""
											wicket:id="firstName">
									</div>
								</div>
								<div class="control-group">
									<label class="control-label" for="lName">Last Name</label>
									<div class="controls">
										<input id="lName" name="lName" type="text"
											placeholder="Last Name" class="input-xlarge" required=""
											wicket:id="lastName">
									</div>
								</div>

								<!-- Text input-->
								<div class="control-group">
									<label class="control-label" for="Address1">Address
										Line1</label>
									<div class="controls">
										<input id="Address" name="Address1" type="text"
											placeholder="Address Line1" class="input-xlarge"
											wicket:id="line1">
									</div>
								</div>
								<div class="control-group">
									<label class="control-label" for="Address2">Address
										Line2</label>
									<div class="controls">
										<input id="Address" name="Address2" type="text"
											placeholder="Address Line2" class="input-xlarge"
											wicket:id="line2">
									</div>
								</div>
								<div class="control-group">
									<label class="control-label" for="City">City</label>
									<div class="controls">
										<input id="City" name="City" type="text" placeholder="City"
											class="input-xlarge" wicket:id="city">
									</div>
								</div>
								<div class="control-group">
									<label class="control-label" for="State">State</label>
									<div class="controls">
										<input id="State" name="State" type="text" placeholder="State"
											class="input-xlarge" wicket:id="state">
									</div>
								</div>

								<!-- Text input-->
								<div class="control-group">
									<label class="control-label" for="mobile">Mobile</label>
									<div class="controls">
										<input id="mobile" name="mobile" type="text"
											placeholder="Mobile" class="input-xlarge"
											wicket:id="mobileNo">
									</div>
								</div>

								<!-- Text input-->
								<div class="control-group">
									<label class="control-label" for="selectbasic">Company</label>
									<div class="controls">
										<select id="select1" name="selectbasic" class="input-large"
											wicket:id="company">
											<option>New</option>
											<option>Infy</option>
											<option>Wells Fargo</option>
										</select>
									</div>
								</div>

								<!-- Text input-->
								<div class="control-group">
									<label class="control-label" for="locality">Locality</label>
									<div class="controls">
										<input id="locality" name="locality" type="text"
											placeholder="Locality" class="input-xlarge"
											wicket:id="locality">
									</div>
								</div>

							</div>
							<div class="span4 offset1 smvlabel">
								<!-- Select Multiple -->
								<div class="control-group">
									<label class="control-label" for="mycircle">My Circles</label>
									<div class="controls">
										<select id="mycircle" name="mycircle" class="input-xlarge"
											multiple="multiple" wicket:id="circles">
											<option>Adobe</option>
											<option>Bridge millenium</option>
											<option>Project X</option>
											<option>Tech span</option>
										</select>
									</div>
								</div>
								<!-- Text input-->
								<div class="control-group">
									<label class="control-label" for="age">Age</label>
									<div class="controls">
										<input id="age" name="age" type="text" placeholder="Age"
											class="input-xlarge" wicket:id="age">
									</div>
								</div>

								<!-- Multiple Radios (inline) -->
								<div class="control-group">
									<label class="control-label" for="sex">Sex</label>
									<div class="controls">
										<span wicket:id="gender" id="radio"></span>
									</div>
								</div>

								<!-- Text input-->
								<div class="control-group">
									<label class="control-label" for="email">Login Email</label>
									<div class="controls">
										<input id="email" name="email" type="text"
											placeholder="Login Email" class="input-xlarge" required=""
											wicket:id="emailId">
									</div>
								</div>

								<!-- Password input-->
								<div class="control-group">
									<label class="control-label" for="password">Password</label>
									<div class="controls">
										<input id="password" name="password" type="password"
											placeholder="Password" class="input-xlarge" required=""
											wicket:id="password">
									</div>
								</div>

								<!-- Password input-->
								<div class="control-group">
									<label class="control-label" for="re password">Retype
										Password</label>
									<div class="controls">
										<input id="re password" name="re password" type="password"
											placeholder="Retype Password" class="input-xlarge"
											required="" wicket:id="confirm">
									</div>
								</div>

								<!-- Select Multiple -->
								<div class="control-group">
									<label class="control-label" for="travel">Travel</label>
									<div class="controls">
										<select id="travel" name="travel" class="input-xlarge"
											multiple="multiple" wicket:id="travels">
											<option>Consumer</option>
											<option>Provider</option>
											<option>Both</option>
											<option>Taxi</option>
										</select>
									</div>
								</div>

								<!-- Select Basic -->

								<!-- add more -->
								<!-- <div class="control-group">
						<label class="control-label" for="textinput"></label>
						<div class="controls">
							<a href="#">Add Vehicle</a>

						</div>
					</div> -->

								<div class="control-group">
									<div class="controls">
										<button type="submit" class="btn btn-primary "
											wicket:id="register">Register</button>
										<button type="reset" class="btn ">Reset</button>
									</div>
								</div>
							</div>
						</fieldset>
					</form>
					<span wicket:id="newCompany"></span>
				</div>
			</div>
		</div>
	</div>
</wicket:extend>